I am hoping that you can help me with this issue. I am currently covered under an excellent employer sponsored health/prescription plan in Florida and have been covered under this plan for 9 years. I am contemplating a move back to NY pending a job offer. My major concern with this will be of course insurance issues. I know that I can maintain my current health plan under COBRA for a period of 18 months after my separation. My concern lies in obtaining coverage under a potential new employer. I know that a period of creditable coverage can be applied to any waiting period for pre-existing condition clause in the new contract. Can an employer sponsored health plan exclude care for HIV in NYS? Can my current carrier deny me a policy should I choose to continue coverage with them as is my right under ERISA after the COBRA period ends? Would the premium be at the going rate for the general public or would they continue me at the rate that was being paid by my previous employer?

This is my most major concern about this relocation, which is something I feel I need to do as I feel my current job may kill me before anything else does. Any help or advice you can offer would be appreciated.

Response from Ms. Franzoi

You are correct that when you leave your current employer, you will be eligible for COBRA coverage for 18 months or until you have coverage under another employer's plan, if earlier. However, please be aware that if your current employer doesn't have employees in NY and that employer's plan is a plan with only Florida based providers, if you were to move to NY, there might not be coverage for you. It is important to determine what is available if you move out of state. Many employers have employees in multiple states and coverages in all of the locations. So if an employee leaves, as long as he stays in or moves to a location where the employer provides medical converage, COBRA will work.

Assuming you take COBRA, there is no ERISA requirement for a plan to offer conversion coverage after COBRA ends. In some states, if the plan is insured, conversion is mandated but this varies by state. If the plan is self-insured, it is not subject to state insurance law so it might or might not offer a conversion policy. Conversion policies are usually more limited in coveraage and more expensive than the COBRA continuation coverage. The conversion policy, if available, will not be the same as your COBRA coverage.

If you are offered a postion by an employer in NY and that employer offers you a health plan, if you enroll in the plan during your intial enroillment period and you haven't had a break in coverage of more than 63 days, even if the plan has a pre-existing condition clause, it won't apply to you. This is because federal law states that someone who enrolls during his initial enrollment period cannot have a pre-existing exclusion period greater than 12 months and the new plan must recognize his Creditable Coverage towards that exclusion period. In this case, you would have 9 years of Creditable Coverage (assumes you do not have a break in coverage of more than 63 days).

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